*Insurance Companies Rejecting Women with History of Cesarean*
*Some Companies Require Surgical Sterilization for Coverage; *
*Trend Gives New Imperative to Learn Ways to Avoid Unnecessary Cesarean*
Redondo Beach, CA, June 1, 2008 – As reported in today’s New York Times,
ICAN has begun tracking an alarming new trend of insurance companies
refusing to provide health insurance for women with a history of cesarean
surgery. In some cases, women are being rejected for coverage outright and
in other case they are being charged significantly higher rates to obtain
the same coverage as women without a history of cesarean. With over a
million women each year undergoing this surgery, this practice has the
potential to render large numbers of women uninsurable.
This trend surfaces as the rate of cesarean surgery, including unnecessary
cesareans, continues to rise. In 1970, the cesarean rate was 5%. In 2007, it
was 30.1%. Experts often cite the incentives within the health care system
for driving up the rate of cesarean unnecessarily, including physicians’
medical malpractice fears, better reimbursement for surgery, and lifestyle
conveniences for care providers and staffing efficiencies in having more
“9-5″ deliveries.
“Women are caught in the middle of a dysfunctional system. Doctors are
telling them they need surgery, even when they don’t, and insurance
companies, who are tired of paying the bill for so many frivolous surgeries,
are punishing women for the poor medical care of doctors,” said Pam Udy,
President of the International Cesarean Awareness Network (ICAN).
The trend is highlighted in the cases of women like Peggy Robertson of
Colorado. When she applied for health insurance coverage with Golden Rule,
her husband and her children were accepted, but her application was denied.
After multiple inquiries directed to the insurance company, she was finally
told that she was denied because she had delivered one of her children by
cesarean. “It was shocking. I assumed that as a woman in good health I would
be readily accepted,” said Robertson. “When I finally found someone who
would explain why my application was denied, they had the audacity to ask me
if I had been sterilized, stating that this was the only way I could get
insurance coverage with them.”
As the incidence of cesarean increases, the evidence of the downstream
medical complications for women and babies, and the associated medical
costs, becomes increasingly apparent. Risks of cesarean in later pregnancies
include increased incidence of infertility, miscarriage, fetal deformities,
overgrowth of scar tissue leading to bowel problems, and potentially deadly
placental abnormalities in subsequent pregnancies.
And though most women with a prior cesarean are being encouraged and often
coerced into having repeat cesareans by their doctors and hospitals that
have banned vaginal birth after cesarean (VBAC), a pair of recent studies
done by the National Institute of Child Health and Human Development
Maternal–Fetal Medicine Units Network demonstrates that women who deliver
vaginally after a cesarean fare significantly better than women who deliver
by repeat cesarean. (Obstetrics & Gynecology 2008;111:285-291, Labor
Outcomes With Increasing Number of Prior Vaginal Births After Cesarean
Delivery, Mercer et al, and Obstetrics & Gynecology 2006;107:1226-1232
Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries,
Silver et al.)
“Most women are looking to avoid cesareans. But physicians often make
surgery difficult to avoid by insisting on non-evidence based practices,”
said Udy. Practices that fail to improve the outcomes for mothers and babies
and increase the risk of cesarean section include inducing for going
post-dates, inducing for suspected large baby, requiring fasting during
labor, requiring women to be confined to bed for continuous fetal
monitoring, and failing to offer continuous support to a mother in labor.
“These care practices serve the system well, but not mothers and babies” Udy
added.
In fact, women and their babies may be paying a higher price than being
denied health insurance. Last August, the Centers for Disease Control
reported that, for the first time in decades, the number of women dying in
childbirth has increased.
http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf Experts note that the
increase may be due to better reporting of deaths but that it coincides with
dramatically increased use of cesarean. The latest national data on infant
mortality rates in the United States also show an increase in 2005 and no
improvement since 2000.
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths05/prelimdeaths05.htm
Internationally, the U.S. ranks 41st in maternal deaths and has the second worst newborn
death rate among industrialized nations.
Women who are seeking information about how to avoid a cesarean, have a
VBAC, or are recovering from a cesarean can visit www.ican-online.org for
more information. In addition to more than 90 local chapters nationwide, the
group hosts an active on-line discussion group that serves as a resource for
mothers.
Women who want to reach their lawmakers can visit http://www.votesmart.org/.
Women who want to reach their state insurance commissioner can visit
http://www.naic.org/state_web_map.htm .
*About Cesareans: **ICAN recognizes that when a cesarean is medically
necessary, it can be a lifesaving technique for both mother and baby, and
worth the risks involved. Potential risks to babies include: low birth
weight, prematurity, respiratory problems, and lacerations. Potential risks
to women include: hemorrhage, infection, hysterectomy, surgical mistakes,
re-hospitalization, dangerous placental abnormalities in future pregnancies,
unexplained stillbirth in future pregnancies and increased percentage of
maternal death. *
http://www.ican-online.org/resources/white_papers/index.html
*Mission statement: **ICAN is a nonprofit organization whose mission is to
improve maternal-child health by preventing unnecessary cesareans through
education, providing support for cesarean recovery and promoting vaginal
birth after cesarean. There are 94 ICAN Chapters across North America, which
hold educational and support meetings for people interested in cesarean
prevention and recovery.*
Contact: Gretchen Humphries (734) 323-8220
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